As you state the 18 tender point exam was never intended as a diagnostic exam. Speaking with many FM patients, most of us have tenderness everywhere. I am a bit disappointed however, that the myofascial trigger points (not tender points) that are present in so many FM patients is not being addressed in this proposed diagnostic criteria. These knotted up pieces of muscle fiber that shorten the taut band of muscle involved, cause dysfunction and could explain the symptoms of numbness and tingling and referred pain. They are easily felt by the examiner (unless under bone or other larger muscles) and have a specific pain and symptom pattern. This is an objective assessment for those trained to identify them.

Have you seen the studies that suggest the presence of chronic myofascial pain from myofascial trigger points may be present in all FM patients? I question, why are we missing this peripheral issue that keeps the FM brain in constant wind-up? As you know I have discussed this exhaustively as a patient and author. Why are those that study us missing this most important piece of objective information, when the research has been done? We have been yearning for objective, measurable, visible criterion, here it is staring us in the face. (See the citings below)